The Terrace
Good

Reports

Inspection carried out on 20 September 2018

During a routine inspection

The Terrace is a residential care home for up to 44 people including people living with dementia, old age, physical disability and mental health difficulties. At the time of inspection, 35 people were living there. The Terrace is converted from a large Victorian style property and is set in its own grounds, with parking facilities. Within the building there is a separate unit where people living with dementia are supported.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited. Staff were supported through on-going supervision and accessed training relevant to people's needs, to ensure these could be met.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. The administration and management of medicines was safe. People's needs were assessed to ensure the service could meet their needs. Staff worked in partnership with health and social care professionals in the monitoring and promotion of people's health.

People were supported by kind and caring staff who promoted their independence. People were supported to maintain contact with family and friends and take an active part in recreational and leisure activities.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider had a system in place for responding to people's concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

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During a routine inspection

This inspection took place on 2 February 2016 and was unannounced. The service was last inspected in June 2014, when the service was found to be compliant with the standards assessed at that time.

The Terrace is registered to provide personal care and accommodation for up to 44 people, including people living with dementia, old age, physical disability and mental health difficulties. The service is not registered to provide nursing care. At the time of our inspection 35 people lived at the service. The home is situated in the market town of Richmond and is set in its own grounds, with parking facilities.

The registered provider is Care UK Community Partnerships Ltd. The service had a registered manager, who had been registered with us since October 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People using the service, their relatives and other professionals told us The Terrace was a safe place. Staff knew how to report any concerns about people’s welfare and had confidence in the registered manager taking appropriate action. Safeguarding concerns had been reported appropriately when needed.

Checks were completed on new staff to ensure they were suitable and there were enough staff on duty to care for people safely.

People had individual risk assessments in place to help ensure staff were aware of the relevant risks and how these should be managed. Medicines were safely stored and staff administered medicines in a safe way.

The service’s premises and equipment were well maintained and in safe working order.

Staff were supported to have the skills and knowledge they needed through relevant training. Staff felt supported and received supervision and appraisal.

The service was following the principles of the Mental Capacity Act 2005. At the time of the inspection eight people were subject to a Deprivation of Liberty Safeguards authorisation, with a further 12 authorisations awaiting assessment by the authorising body.

People told us that the food was good and snacks and drinks were available between meals if people wanted them. People’s dietary needs were assessed and monitored.

We received positive feedback from two health care professionals, who told us the service worked well with them and provided a good standard of care to people.

People told us that staff treated them well, and with dignity and respect. People and relatives expressed satisfaction with people’s care and how they were treated.

Care staff knew people well and were able to answer our queries about people’s individual needs. People had their needs assessed and had care plans in place, which were regularly reviewed. Some care plans were basic and would benefit from the inclusion of more person centred information, but the registered manager was already aware of this and in the process of making improvements.

People had access to activities and were being given the opportunity to be involved in developing and improving how activities were provided. Visitors were made welcome and could visit when they wanted.

A complaints procedure was in place and information about this was available in the reception area and people’s rooms. Complaints had been recorded and responded to appropriately.

Audits and checks were completed and a service improvement plan was in place, to help the service continually improve.

People who used the service, relatives and other professionals told us the registered manager was well thought of, approachable and that the home provided a good service. The atmosphere was described as good and people said they would recommend the home.

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During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re assessed regularly.

There were sufficient care workers to respond to people's health and welfare needs, A person who used the service told us "I am always attended to promptly, there are always enough staff around. " Another person said "Staff are very busy but they do have time to spend with me, we never have to wait." However, one person did say they felt there was a shortage of staff but also commented that they were attended to and never had to wait when they pressed the call bell.

Is the service effective?

People’s health and care needs were assessed and detailed care plans and risk assessments were in place. This helped to ensure that people’s needs were met.

Systems were in place for the provider to monitor if the service being provided was effective to meet people’s needs. Action was taken to ensure people remained happy with all aspects of the service they received.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw that staff acted in a kind and respectful way. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example assisting people to knit.

People we spoke with knew how to make a complaint if they were unhappy.

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

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During a routine inspection

We highlighted some areas for improvement during this visit, but it was unclear if this was related to the temporary disruption caused by the major refurbishment work that was taking place, or as the result of ongoing issues.

People who used the service felt that they were involved in day to day decisions about their care, although we found that the recording of people's consent and involvement in care planning could be improved.

People told us that they felt well cared for and were treated well by the staff. Comments made by people who lived at the home included “We are well looked after, we have no complaints” and “I enjoy it in here and I am very grateful.” Systems were in place to assess, plan and review people’s care needs.

People were happy with the food provided. Comments made to us included “We are well fed”, “There is plenty of choice” and “I enjoy the roast dinners.” We saw that people received regular meals and drinks throughout the day and that their nutritional wellbeing was monitored.

People spoke well of the staff, but we received comments from people who used the service, relatives and staff suggesting that staff were not always available to meet people’s needs. Our observations during the visit supported these views.

The Terrace benefited from Care UK Limited’s corporate quality management systems and input from the clinical governance team. This meant that systems were in place to regularly assess and monitor the quality of service.

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During a routine inspection

We spoke to five people who use the service who were able to tell us about their experiences. They told us “they look after me” and “I like it, it’s very good”, but also said “there’s not a lot going on” and “you spend a lot of time just sitting.”

We spoke with three relatives of people who use services. Comments included “People are looked after well”, “staff are wonderful” and “they keep me involved and I have an input into the care”.

We spoke with four of the home’s care staff and the recently appointed home manager. Staff told us that were well supported by the new manager and thought that the home provided a good service, although the job had been very hard work recently due to service being short staffed.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.